Hepatic Encephalopathy

Alternative names:

encephalopathy - hepatic; hepatic coma

Treatment:

Hepatic encephalopathy is an acute medical condition that may become a medical emergency. Hospitalization is required.

The goals of treatment include life support, elimination or treatment of precipitating factors, and removal or neutralization of ammonia and other toxins. Life support including support of breathing or circulation may be required, particularly if coma develops. Cerebral edema (brain swelling) may occur and may be life threatening.

Precipitating factors must be identified and treated. Gastrointestinal bleeding must be stopped. This often requires endoscopy (use of a scope) and cauterization or other means to control bleeding. The intestines must be emptied of blood. Blood breaks down into protein components that are converted to ammonia. Magnesium citrate or other laxatives, and/or enemas are used to evacuate the intestines.

Reduced or no protein in diet is prescribed to reduce ammonia production. Vegetable protein may be tolerated better than animal protein. Specially formulated intravenous or enteric feedings (tube feedings) may be necessary.

Lactulose prevents absorption of ammonia from the intestines and acts as a laxative to evacuate blood from the intestines. Neomycin may be given by mouth to reduce ammonia production by intestinal bacteria. Sedatives, tranquilizers, or any other medication that is metabolized or excreted by the liver should be avoided. Medications containing ammonium (including certain antacids) should be avoided. Other medications and treatments may be recommended, with variable results.

Expectations (prognosis):

Acute hepatic encephalopathy may be reversible, while chronic forms of the disorder are often progressive. Both forms may result in irreversible coma and death, with approximately 80% fatality if coma develops. Recovery and recurrence are variable.

Complications:

• cerebral edema (brain swelling)
• brain herniation
• progressive, irreversible coma
• permanent neurologic losses (movement, sensation, or mental state)
• increased risk of:
  • sepsis
  • respiratory failure
  • cardiovascular collapse
  • kidney failure

• side effects of medications (see the specific medication)

Calling your health care provider:

Call your health care provider if any change in mental state or other neurologic function occurs, particularly if there is known or suspected liver disorder. Hepatic encephalopathy can rapidly progress to become an emergency condition!